Advertisement

Pharmacy World & Science

, 31:622 | Cite as

Change of initial oral antidiabetic therapy in type 2 diabetic patients

  • Arian PlatEmail author
  • Fernie Penning-van Beest
  • Sophia Kessabi
  • Martijn Groot
  • Ron Herings
Short Research Report

Abstract

Objective To explore the ‘real-life’ therapy of type 2 diabetes mellitus with oral antidiabetic drugs (OADs). Methods From the PHARMO Record Linkage System comprising linked drug dispensing and clinical laboratory data from approximately 2.5 million individuals in the Netherlands, among others, new users of OADs were identified in the period 1999–2004. New users, aged 30 years and older, without insulin use before cohort entry date and with at least one year follow-up were included. We determined per initial therapy patient characteristics and first therapy change. Results Overall 35,514 patients were included. Metformin and sulfonylureas (SU) were the most frequent initial therapy. Patients on thiazolidinedione (TZD) monotherapy had lower percentages baseline HbA1c ≥ 7% compared to patients on metformin and SU. The proportion of patients still on initial therapy after one year ranged from 46% (TZDs) to around 60% (SU). Among patients starting on monotherapy, add-on (15–20%) and discontinuation (16–25%) of therapy occurred most frequently. In patients starting on combination therapy, a switch occurred in 30% of the patients. Conclusion In more than 40% of the patients a change in initial OAD-therapy is already observed in the first year of therapy. Maintaining patients on initial therapy remains a challenge.

Keywords

Diabetes Netherlands Oral antidiabetic agents Pharmacoepidemiology Treatment pattern 

Notes

Acknowledgements

The authors wish to thank Sjoukje van der Bij for analyzing the data and Michiel van der Linden for his valuable comments on the manuscript.

Funding

This study was financially supported by an unrestricted grant from Novartis Pharma AG, Basel, Switzerland.

Conflict of interest statement

The PHARMO Institute performs financially supported studies for several pharmaceutical companies, including Novartis.

References

  1. 1.
    World Health Organisation [www.who.int]. Geneva: Diabetes Facts Sheets (2008); [cited 2009 February 26]. Available from: http://www.who.int/mediacentre/factsheets/fs312/en/index.html/.
  2. 2.
    Ukpds G. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:854–65.CrossRefGoogle Scholar
  3. 3.
    Herings RM, Bakker A, Stricker BH, Nap G. Pharmaco-morbidity linkage: a feasibility study comparing morbidity in two pharmacy based exposure cohorts. J Epidemiol Community Health. 1992;46:136–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Catalan VS, Lelorier J. Predictors of long-term persistence on statins in a subsidized clinical population. Value Health. 2000;3:417–26.CrossRefPubMedGoogle Scholar
  5. 5.
    Burgers JS, Bailey JV, Klazinga NS, Van Der Bij AK, Grol R, Feder G. Inside guidelines: comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries. Diabetes Care. 2002;25:1933–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11:44–7.PubMedGoogle Scholar
  7. 7.
    Boccuzzi SJ, Wogen J, Fox J, Sung JC, Shah AB, Kim J. Utilization of oral hypoglycemic agents in a drug-insured U.S. population. Diabetes Care. 2001;24:1411–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Rutten GEHM, De Grauw WJC, Nijpels G, Goudswaard AN, Uitewaal PJM, Van der Does FEE, et al. NHG-standaard diabetes mellitus type 2 (tweede herziening) [NHG Practice Guideline Diabetes Mellitus Type 2 (second revision)]. Huisarts Wet. 2006;49:137–52.Google Scholar
  9. 9.
    Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus. Drugs. 2005;65:385–411.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Arian Plat
    • 1
    Email author
  • Fernie Penning-van Beest
    • 1
  • Sophia Kessabi
    • 2
  • Martijn Groot
    • 3
  • Ron Herings
    • 4
    • 5
  1. 1.PHARMO Institute UtrechtThe Netherlands
  2. 2.Novartis Pharma AGBaselSwitzerland
  3. 3.Novartis Pharma B.V.ArnhemThe Netherlands
  4. 4.PHARMO InstituteUtrechtThe Netherlands
  5. 5.Department of Health Policy & ManagementErasmus Medical CentreRotterdamThe Netherlands

Personalised recommendations